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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Houston and Surrounding Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Care (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Dual Care (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Dual Care (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Dual Care (HMO D-SNP) prescription drug plan features an annual deductible of $615. Beneficiaries enjoy no copay for both Tier 1 preferred generic and Tier 2 generic drugs. This $0 cost applies to one-month, two-month, and three-month supplies filled at standard retail pharmacies or through standard mail order. For brand-name and specialty medications, coverage costs are calculated as a percentage of the drug cost. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail order fills. Tier 5 specialty tier drugs also carry a 25% coinsurance for a standard one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for essential services like primary care, specialist visits, home health care, and skilled nursing facility stays. For acute care, inpatient hospital stays require a $1,730 copay per admission, while emergency room visits carry a $115 copay. Other key medical services, including outpatient care, diagnostic tests, dialysis, and durable medical equipment, generally feature no copay alongside a 20% coinsurance. Additionally, members can take advantage of valuable extra benefits such as routine dental, vision, hearing aid allowances, and a monthly over-the-counter benefit, mostly with no copays.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,730 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient services with no copays, though a coinsurance of up to 20% and prior authorization requirements apply to most care. This includes outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, all of which feature no copay and coinsurance ranging from 0% to 20%.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Dual Care (HMO D-SNP) and requires prior authorization. Depending on the care received, you will pay either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance, offering up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Care (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a maximum benefit of $250,000.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care, specialist visits, therapy, mental health, and telehealth services with no copay and no coinsurance. Although chiropractic services are not covered in practice, the plan includes up to 12 routine podiatry visits per year with no copay or coinsurance.
Preventive Services See details
Preventive Services under the Aetna Medicare Dual Care (HMO D-SNP) are partially covered, offering an annual physical exam and select supplemental benefits with no copay and no coinsurance, while other screenings and education services require no copay and 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers hearing services, offering routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $1,000 maximum per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services, offering routine and diabetic eye exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is also covered up to a $250 annual combined limit, featuring no copay for eyeglasses and frames, and a 20% coinsurance with no copay for contact lenses.
Dental Services See details
Aetna Medicare Dual Care (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance, alongside other diagnostic and preventive services with no copay and no coinsurance up to a $1,000 annual limit. While many comprehensive services like oral surgery and periodontics are covered with no copay or coinsurance, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic equipment with no copay, though prior authorization is required. A 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. There is a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Aetna Medicare Dual Care (HMO D-SNP) with no copay, but only some services are covered because cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay or coinsurance, and a prior three-day inpatient hospital stay is not required. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for chronic illness meal benefits, annual wellness exams, additional gFOBT and FIT screenings, and up to $60 monthly for over-the-counter items. Acupuncture, highly integrated services, and other unspecified services are not covered under this benefit.
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